Research Assessment #3

Date:​ September 25, 2018

Subject:​ Physical Therapy in Emergency Medicine

MLA or APA citation:

Cheney, Christopher. “Yes, Physical Therapy Is OK in Emergency

Departments.” ​Medpage Today​, Medpage Today, 12 Aug. 2018,

www.medpagetoday.com/emergencymedicine/emergencymedicine/74518.

Analysis:

There are many different departments that work together to enable an

Emergency Room to function efficiently. In today’s fast-changing world, there has been

a shift to incorporating a physical therapy department into the Emergency Room. With

this addition, there are many different benefits that come to light that can take off some

of the weight of the Emergency Doctors as well as provide care for patients. This

resource can bring a new perspective into the patient's case making sure their diagnosis

and treatment is appropriate and is the best course to take.

Through this article, I was able to uncover the many advantages of the

Emergency Department Physical Therapists Program. This new integration brings in

Physical Therapist as a consultant that assists Emergency Physicians in the medical

evaluation as well as treatment with disorders having to do their movement and

functionality. The physical therapists would mainly deal with cases that involve lower

back pain, peripheral vertigo, and gait disturbances. Emergency Department Physical

Therapists are more than qualified to provide their expertise in musculoskeletal and
vestibular condition. This combined with the special attention that they receive with the

Physical Therapists provides an individual care improving their care and their overall

recovery in the Emergency Room.

The number of these specialized programs has increased incredibly over the last

decade. However I was shocked to find out, the creation of this unique program has

many complex steps in order to make it a success. The first major step to start up this

program is to engage stakeholder. To make sure everything goes smoothly it is

recommended to establish a solid relationship with the physical therapy department or

there leader before to ensure an effective transition into the program. The same concept

applies to the Physical therapist reaching out to the emergency doctors. The addition of

Physical Therapist can greatly improve the bed capacity as well because the skills they

bring can decrease the prolonged stay in an ER.

I also discovered another factor that comes into play, which is the estimating

clinical volume. The main constraint revealed through this program is the consult

volume hindered by the number of physical therapists(FTE). This article also exposed

me to some of the characteristics that an Emergency Department Physical Therapists

should possess. They have to have effective communication skills when dealing with

multiple patients at the same time. Having the quality of being flexible also helps an ED

Physical Therapist because they never know what situation they will run into the ER.

(Article starts on page 3 and ends on page 5)

Yes, Physical Therapy is OK in Emergency Departments
Tips for building a program

by Christopher Cheney, HealthLeaders Media August 12, 2018

Emergency department physical therapy (ED PT) offers multiple benefits and is
poised to spread across the country, researchers said.

Physical therapists augment ED care teams, the team ​reported​ online in the
American Journal of Emergency Medicine.

"Patients receiving ED PT benefit from the physical therapist's expertise in

musculoskeletal and vestibular conditions​ and from the​ individualized attention
provided in a typical bedside evaluation and treatment session, which includes
education on expected symptom trajectory, recommendations for activity
modulation, and facilitated outpatient follow-up."

While common in Australia and the United Kingdom, ED PT has established a

modest foothold in the United States, with ​programs at 23 health systems​ as of
2014.

The researchers pointed to the​ three key steps to creating an​ ED PT program:
engaging stakeholders, estimating clinical volume, and staffing PT positions with
qualified professionals.

1. Stakeholders Engagement

Most ED physical therapists are drawn from a health system or hospital physical
therapy department because using existing organizational infrastructure is often
the most efficient option, the researchers wrote. "Engagement with physical
therapy departmental leadership is a ​foundational step​ in establishing an ED PT
program."

Engaging the ED leadership is also essential because PT services are provided in

ED patient rooms or hallways.

Bed capacity​, however, is a potential stumbling block to engaging ED leadership,

who can be concerned that​ prolonged patient stays reduce bed capacity​. Timely
PT consults are the solution: "We posit that prolonged lengths of stay likely
reflect a delay in initiating the PT consultation request, and a formal workflow for
early PT consultation is likely to make this process more efficient."

Finally, ED care providers such as resident and attending physicians, nurse

practitioners, physician assistants, and registered nurses should be consulted to
gauge their support for an ED PT service.

2. Clinical Volume Estimation

The article highlights physical therapy visit data at several EDs. On the low end of
the scale, with one full-time physical therapist in the ED, Barnes-Jewish Hospital
in St. Louis posted ​565 annual PT ED visits in 2009 with an annual ED-visit
census of 62,000.

On the high end of the scale, with two full-time physical therapists, Indiana
University Methodist Hospital in Indianapolis posted 2,000 annual PT ED visits
in 2014 with an annual ED-visit census of 102,000.

"The experience of these ED PT programs may indicate that ​consult volume is

constrained by the number of FTE physical therapists ​rather than annual ED
census," the authors wrote.

3. Physical Therapist Qualities

Strong communication skills​ are essential for ED physical therapists: "An ideal
ED physical therapist will have good patient communication skills, given the
volume of information that patients are likely to receive in a short period of time
from the ED care team."

Mirroring a crucial ER physician skill, ED physical therapists must be ​flexible

and improvisational​. "ED physical therapists must also function as a
'jack-of-all-trades' and should therefore have a ​wide range of clinical skills​ that
can be ​adapted to address the variety of patient problems​ encountered in the
acute care setting."

PT ED: Clinical Care

Physical therapy has three primary clinical applications in the ED, according to
the researchers:
 ● Acute musculoskeletal injuries​ are most frequently neck or back pain, but also
include hip, knee, and shoulder pain
● With training in ​vestibular conditions​, physical therapists are well-suited to treat
peripheral vertigo, such as giving patients self-directed therapeutic maneuvers
and assessing discharge safety
● Gait training and assessment in the ER​ is a prime ​service area​ for physical
therapists, with several clinical applications including home safety and
disposition planning for orthopedic devices such as crutches and knee scooters

ED PT programs are generating positive results, the authors concluded: "Initial

reports from U.S. hospital systems that have established ED PT services have
cited ​increased provider and patient satisfaction, decreased wait times, and
decreased rates of admission to the hospital for patients with orthopedic
conditions​."

​ ealthLeaders Media​.
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